Abstract ? Project 3 Advances in genomic technology have now enabled massively parallel sequencing of multiple putative cancer genes. Although progress on the technical side of genetic testing has been rapid, clinician understanding of the results of next generation sequencing genetic testing and communication of results accurately and effectively to patients has lagged. In turn, the patient's ability to understand the results, communicate them to family members or significant others, and make informed decisions about screening or preventive options is less than optimal. Studies suggest that attitudes towards genetic risks and related communication vary significantly across race and ethnicity. In spite of its obvious importance, studies of this dynamic process of communication and understanding of genetic information in the current context of sequencing based results are limited and they are rare in racial/ethnic minorities. We propose a multi-ethnic, multi-lingual, two-site study (Stanford University Health Alliance and University of Southern California Los Angeles County Hospital) of how breast cancer genetic risk information is communicated to Hispanic, Chinese and Non-Hispanic White women, what they understand, how they respond and with whom they share this information. We will concurrently trace the patient longitudinally over a one-year period to determine what health decisions they make related to their cancer risk. We have the following specific aims. Specific Aim 1: To assess genomic confidence of clinicians communicating genetic test results and genetic risk information on breast cancer to the diverse patients in both study sites. Specific Aim 2: To audiotape the information that clinicians communicate during the clinical encounter in delivering genetic test results to diverse patients and to assess whether the information that is provided to patients differs by patient ethnicity, health literacy, and study site. Specific Aim 3: To assess the correspondence between the recommendations of doctors and the subsequent actions of patients over a one-year period and whether this correspondence differs by ethnicity, health literacy, and study sites. Specific Aim 4: To identify if/when patients share their personal genetic risk information with family member(s) and to what extent this process is influenced by ethnicity, health literacy, and study sites. Our proposed study will fill an important and growing knowledge gap about how ethnic minorities utilize and if they benefit from cancer genetic risk information and related recommendations. Findings from this study will be critical and lead to a better understanding of how to culturally adapt precision medicine recommendations to best provide high-quality care for diverse populations and thereby mitigate health disparities.